Traumatic brain injury (TBI) is the leading cause of acquired disability in children, affecting approximately a half million children each year in the United States5. However, previous research has failed to examine the longer-term functional outcomes of early TBI in everyday settings such as school and home. Understanding performance in everyday settings provides critical information on residual impairments and suggests targets for intervention. Participants: Building on findings from an ongoing prospective investigation of TBI in young children, this study will examine long-term functional outcomes in 70-85 children who sustained a TBI between 3 and 7 years of age and who will be at least 10 years of age at long-term follow-up. Outcomes for the TBI group will be evaluated relative to those in a comparison group of 70-85 children who sustained orthopedic injuries not involving the CNS at the same age. The children are part of a multi-site, longitudinal cohort who have completed evaluations of their cognitive abilities, adaptive functioning, and social environments at four time points over the initial 18-months post injury. Method: Our overarching goals are: 1) to characterize long-term, functional outcomes following early TBI, 2) to examine the role of executive functions (EF) as a mediator of functional outcomes, and 3) to identify risk and protective factors in the school and home environment. Long-term follow-up assessments will be conducted in three distinct settings: the classroom, the child's home, and the laboratory/clinic. Primary measures of everyday functioning include a structured clinical interview of the child's functioning in the home and communityand a validated classroom observation that assesses multiple learning characteristics, including task engagement and attention. The home environment will be assessed using both standardized ratings and a formal observational scale (HOME). Observations of the home and classroom environment will provide information about social moderators of long-term functioning and will help identify effective instructional approaches. Differences between the TBI and OI groups will be analyzed by means of univariate or multivariate analysis of covariance. This investigation will also examine the emergence of EF in preadolescence following early TBI and the role of deficits in these skills as mediators of the effects of TBI on functional outcomes. Predictors/moderators of long-term outcomes will be examined by means of multiple linear regression analysis and general linear mixed model analysis. Path analyses will be used to explore the relative importance of TBI and the environmental factors as predictors of everyday functional outcomes. Conclusion: Extending follow-up of a valuable prospective cohort and building on a productive, nearly 20-year collaboration among the investigators, this project will clarify the developmental implications of early childhood TBI. By identifying factors related to long-term learning and behavior, the project will also shed new light on ways to promote children's later functioning. PUBLIC HEALTH RELEVANCE: TBI is the leading cause of acquired disability in childhood, however little is known about long-term functioning in everyday settings or factors contributing to successful adaptation. The proposed project will examine influences on long-term everyday functioning at school, at home, and in the community in a prospectively recruited cohort of children who sustained TBI between the ages of 3 and 7 and a comparison cohort of children who sustained orthopedic injuries at the same age. Findings will yield important information about how to reduce psychosocial disability and improve long-term, real world functioning following TBI.